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Lack of benefit for routine functional testing early after coronary artery bypass graft surgery: results from the
1, Mark J Eisenberg, Karen Wou
1Jewish General Hospital/McGill University, Montréal, Québec, Canada.
Insights
Routine functional testing after coronary artery bypass graft surgery (CABG) showed fewer cardiac procedures and similar clinical events compared to selective testing. This suggests routine testing may not be necessary post-CABG.
Area of Science:
- Cardiology
- Cardiac Surgery
- Clinical Trials
Background:
- The optimal strategy for functional testing after coronary artery bypass graft surgery (CABG) remains debated.
- Physicians currently utilize either routine or symptom-driven approaches for post-CABG functional testing.
Purpose of the Study:
- To evaluate the impact of routine functional testing on subsequent cardiac procedures and clinical events in patients following CABG.
- To compare outcomes between routine and selective functional testing strategies in the first year after CABG.
Main Methods:
- A prospective, multicenter cohort study (ROSETTA-CABG Registry) involving 408 patients who underwent successful CABG.
- Analysis of functional testing, cardiac procedures, and clinical events within 12 months post-surgery.
- Comparison of outcomes between patients managed with routine versus selective functional testing strategies.
Main Results:
- Patients undergoing routine functional testing had significantly fewer cardiac catheterizations (0.9% vs. 8.1%, p=0.027) but similar revascularization rates compared to the selective group.
- Clinical events such as unstable angina, myocardial infarction, and death were less common in the routine testing group.
- The majority of adverse events occurred in the selective testing group, particularly those with positive functional tests.
Conclusions:
- Routine functional testing one year after CABG is associated with very low rates of clinical events.
- The current data do not support the routine use of functional testing as a standard strategy following successful CABG.
- Further research may explore tailored approaches based on individual patient risk profiles.
Background:
There is little consensus regarding the use of functional testing after coronary artery bypass graft surgery (CABG). Some physicians opt for a routine functional testing strategy, while others employ a symptom-driven strategy.
Objective:
To examine the effects of routine post-CABG functional testing on the use of follow-up cardiac procedures and clinical events.
Methods:
The Routine versus Selective Exercise Treadmill Testing after Coronary Artery Bypass Graft Surgery (ROSETTA-CABG) Registry is a prospective, multicenter cohort study examining the use of functional testing after CABG among 408 patients. The frequencies of functional testing, cardiac procedures, and clinical events were examined during the first 12 months following a successful CABG.
Results:
Patients were predominantly male (80%) with a mean age of 63 +/- 10 years. During the 12-month follow up, 111 patients were observed to undergo a routine functional testing strategy, while 284 patients underwent a selective strategy. Patients undergoing routine functional testing underwent fewer follow-up cardiac catheterizations, but similar numbers of revascularization procedures (cardiac catheterizations = 0.9% vs. 8.1%; p = 0.027; percutaneous coronary intervention [PCI] = 0.9% vs. 4.6%; p = NS; repeat CABG = 0.0% vs. 0.0%; p = NS, respectively). However, clinical events were less common among patients who underwent routine functional testing including unstable angina (0.0% vs. 6.4%; p = NS), myocardial infarction (MI) (0.0% vs. 2.1%; p = NS), and death (0.9% vs. 1.4%; p = NS). The majority of clinical and procedural events occurred in the selective group who had a positive functional test (clinical events = 33%; procedural events = 40%). In contrast, no events occurred in patients in the routine group with a positive or indeterminate test, while those with a negative test had more events (6.3%) and procedures (6.3%).
Conclusions:
Because routine functional testing 1 year after CABG is associated with extremely low event rates, this strategy does not appear to be warranted.
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